Individual
MARY BENSON STACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
950 LANEY WALKER BLVD, AUGUSTA, GA 30901-2960
(706) 721-5853
Mailing address
1948 BOLIN RD, NORTH AUGUSTA, SC 29841-2215
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RN134680
GA
Other
Enumeration date
01/18/2007
Last updated
07/08/2007
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